
    <html>
        <head>
            <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
            <title>Doctor Registration</title>
            <link href="style.css" rel="stylesheet" type="text/css" />
            <link href="calendar.css" rel="stylesheet" type="text/css" />
            <link href="validate.css" rel="stylesheet" type="text/css" />
            <script src="calendar.js" ></script>
            <script src="ajaxscript.js"></script>        
        </head>    
        <body>
            <div id="header"></div>
            <div id="navigation"><ul>
                    <li><a href="#">Home</a></li>
                    <li><a href="register.html">Registration</a></li>
                    <li><a href="#">Products</a></li>
                    <li><a href="#">Services</a></li>
                    <li><a href="#">Contact us</a></li>
                </ul></div>
        <center>
            <form name="dregister" id="dregister" method="post" onsubmit="return validate(this)" action="./doctor">
                <table border="0" style="background:#669d37">
                    <tr> 
                        <td> <font size="4"><b><font color="red">*</font>Doctor name </b></font> </td> 
                        <td><input  type="text" name="dname" id="dname" /></td>
                        <td rowspan="2"><img src="" height="130" width="120" /></td>
                    </tr>     		

                    <tr> 
                        <td> <font size="4"><b><font color="red">*</font>Gender </b></font> </td> 
                    </tr>
                    <tr>
                        <td>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                            <strong><input type="radio" name="gender" value="male" checked/>male</strong></td>
                        <td>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                            <strong><input type="radio" name="gender" value="female"/>female</strong></td>
                    </tr>               		

                    <tr> 
                        <td> <font size="4"><b><font color="red">*</font>username </b></font> </td> 
                        <td><input  type="text" name="username" id="username" onblur="checkuser();"/></td>
                        <td><div id="id1">please enter unique doctor</div></td>
                    </tr>                   

                    <tr> 
                        <td> <font size="4"><b><font color="red">*</font>Password</b></font></td> 
                        <td><input  type="password" name="password" id="password"/></td>
                    </tr>                   

                    <tr> 
                        <td> <font size="4"><b><font color="red">*</font>Re-enter Password </b></font> </td> 
                        <td><input  type="password" name="repassword" id="repassword"/></td>
                    </tr>
                    

                    <tr>
                        <td> <font size="4"><b><font color="red">*</font>Address</b></font></td>
                        <td><textarea rows=5 cols=15 name="address" id="address" ></textarea></td>
                    </tr>


                    <tr> 
                        <td> <font size="4"><b><font color="red">*</font>EmailId </b></font> </td> 
                        <td><input  type="text" name="email" id="email" maxlength="50"/></td>
                    </tr>
                    

                    <tr> 
                        <td> <font size="4"><b><font color="red">*</font>Contact no . </b></font> </td> 
                        <td><input  type="text" name="mobile" id="mobile" maxlength="10"/></td>
                    </tr>                    

                    <tr>
                        <td><font color="red">*</font><b>Departments:</b></td>
                        <td>
                            <select name="dept" id="dept">
                                <option value="heart">heart</option>
                                <option value="neurology">neurology</option>
                                <option value="hematology">hematology</option>
                                <option value="orthopedics">orthopedics</option>
                                <option value="gasterology">gasterology</option>
                                <option value="urology">urology</option>
                                <option value="nephrology">nephrology</option>
                                <option value="endocrinology">endocrinology</option>
                                <option value="gynacology">gynacology</option>

                            </select>
                        </td>
                    </tr>
                    
                    <tr> <td> <font color="red">*</font><font size="4"><b>experience</b></font> </td> 
                        <td><input  type="text" name="experience" id="experience"/></td>
                    </tr>
                    

                    <tr>
                        <td> <font color="red">*</font><font size="4"><b>Max Qualification</b></font> </td>
                        <td><input type="text" name="qual" id="qual" /></td>
                    </tr>

                    <tr>
                        <td><font size="4"><b>Image </b></font></td>
                        <td><input type="file" name="image" style="width:2px"/></td>
                    </tr>
                    
                    <tr>
                        <td>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                            &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td>
                        <td><input type="submit" name="register" value="Register" style="width:100px;margin-top:50px"/></td>
                    </tr>
                </table>
            </form>
        </center>
    </html> 